Pain and inflammation relief is of prime importance to anyone treating patients undergoing surgery. Proper pain and inflammation relief imparts significant physiological and psychological benefits to the patient. Not only does effective pain and inflammation relief mean a smoother more pleasant postoperative course (e.g., mood, sleep, quality of life, etc.) with earlier discharge from medical/surgical/outpatient facilities, but it may also reduce the onset of chronic pain and inflammation syndromes (e.g., fibromyalgia, myalgia, etc.).
Pain serves a biological function. It often signals the presence of damage or disease within the body and is often accompanied by inflammation (redness, swelling, and/or burning). In the case of postoperative pain and inflammation it may be a result of the surgery, or other treatments such as, for example, management of acute pain following burns or non-surgical trauma. The goal for postoperative pain and inflammation management is to reduce or eliminate pain and inflammation discomfort with medication that cause minimum or no side effects.
The site of the surgery has a profound effect upon the degree of postoperative pain and inflammation a patient may suffer. In general, operations on the thorax and upper abdomen are more painful and have more inflammation than operations on the lower abdomen, which in turn are more painful and have more inflammation than peripheral operations on the limbs. However, any operation involving a body cavity, large joint surfaces, the spine or deep tissues should be regarded as painful and have some degree of inflammation. In particular, operations on the thorax or upper abdomen may produce widespread changes in pulmonary function, an increase in abdominal muscle tone and an associated decrease in diaphragmatic function. The result will be an inability to cough and clear secretions, which may lead to lung collapse and pneumonia. Prolonged pain and inflammation can reduce physical activity and lead to venous stasis and an increased risk of deep vein thrombosis and consequently pulmonary embolism. In addition, there can be widespread effects on gut and urinary tract motility, which may lead in turn to postoperative ileus, nausea, vomiting and urinary retention. These problems are unpleasant for the patient and may prolong hospital stay. Most patients who experience moderate to severe postoperative pain and inflammation often require pain and inflammation control at least in the first 3 days after trauma or surgery.
One area that is ripe for pain and/or inflammation due to trauma or surgery is the nasal and sinus cavities. Physicians are frequently called upon to treat nasal and sinus cavities as a result of tissue desiccation, trauma, infection, or other nasal and sinus diseases. Another area that is also affected by pain and inflammation is cardiac tissue. For example, during a myocardial infarction, commonly known as a heart attack, the blood supply to part of the heart is interrupted. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period, can cause damage and/or death (infarction) of heart muscle tissue resulting in pain and inflammation.
Many treatment options for nasal, sinus and cardiac tissues involve administering analgesic and/or anti-inflammatory medications by oral and parenteral routes (e.g., intramuscular or intravenous, subcutaneous routes). These routes for drug administration often result in off target effects, which can cause increased adverse side effects.
Unfortunately, currently available analgesics and/or anti-inflammatory formulations, although effective for short term relief of pain and/or inflammation, require frequent single dose administration every 4 to 12 hours on an as needed basis. These single dose analgesics and/or anti-inflammatory formulations are inconvenient and may interfere with the patient's postoperative inpatient and/or outpatient daytime activities and nighttime sleep and recovery.
New analgesics and/or anti-inflammatory compositions and methods are needed to treat or reduce postoperative pain and/or inflammation at or near cardiac tissue or within the nasal or sinus cavity. New analgesics and/or anti-inflammatory compositions and methods that reliably provide long acting analgesic and anti-inflammatory effects over periods of 3 to 10 days are needed.